Regarding the “individual mandate” described today, my concern is with the policy and with the rhetoric. With all this talk about the hidden tax, the Governor comes dangerously close to blaming the victim.

We reject reforms that send the message to patients and consumers, “It’s your fault,” especially when it is not.

With all the problems and players in the health care system—with insurers who profit by denying care, drug companies that price-gouge, employers who don’t offer coverage, and others—can it be true that the Governor’s “individual mandate” proposal places the harshest punishment not on those interests but on uninsured Californians?

Who are the uninsured? More than 80% are workers, or family members of workers. The vast majority are citizens and legal residents. (Let’s be clear: we have a legal and public health obligation to provide care to all Californians, but even if we didn’t have a single immigrant in the state, we would still have a major health crisis to fix.)

The uninsured are not so by choice—they want coverage, but are largely not eligible for on-the-job benefits or public programs, and find buying coverage unaffordable or unavailable, because of “pre-existing conditions.” The notion of “individual responsibility” is felt now by uninsured families that face the real health and financial consequences.

It’s just incorrect that uninsured people simply get “free care.” Even when they go to the emergency room, they get a bill. In fact, Governor Schwarzenegger signed two bills we sponsored last year to try to rectify the longstanding problem that uninsured working families often get charged more for care (for hospital care or prescription drugs) than anybody else in the system, because they don’t have an insurer or public program to bargain for them. As a result, many uninsured face medical debt and bankruptcy.

An individual mandate only makes sense if you think the problem is that people don’t want health coverage. But we know that if people are eligible for employer-based coverage or public programs, they overwhelmingly take them up. The Health Access California website features a paper [PDF] opposing the individual mandate: the subtitle is “Unwarranted, unworkable, and unwise.”

The question by our Dust-Up moderators suggest that the problem is the so-called “young immortals,” those 20-something Californians supposedly too hip to have insurance. While young people are disproportionately uninsured, the reason is not their youth, but their lower incomes and job type.

The difference is entirely explained by the fact that they are more likely to work at McDonald’s or Wal-Mart, at lower-income jobs that are less likely to provide health coverage. If offered coverage, they overwhelmingly take it up, just like older people. They just are more likely to have to wait 20 months to get coverage, yet the Governor’s plan would force this $28,000 entry-level worker to buy coverage without any help from her employer or elsewhere.

Young people aren’t shunning health care. In fact, given their past voting records, I would argue that if we win health reform this year, it will be because of the support of young Californians.

So I don’t disagree with the Governor’s point about the “hidden tax,” that having so many uninsured creates a strain on the health system as a whole, and that we all have a stake in health reform. But don’t think the uninsured don’t want coverage, or that they get off with free care and without consequence.

One last thing: he cited opposition to the “individual mandate” as a “Democratic” concern. But last time I checked, I didn’t see support for this particular component from the Republican side either. Maybe it is a truly “post-partisan” idea…